Clues to occult cancer in patients with ischemic stroke

PLoS One. 2012;7(9):e44959. doi: 10.1371/journal.pone.0044959. Epub 2012 Sep 12.

Abstract

Background: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke.

Methods and findings: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke) group and without active cancer (CR-stroke) group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control). Clinical factors, lesion patterns on diffusion-weighted MRI (DWI), and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4%) patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001). Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001). D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001) and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001) were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients.

Conclusion: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / complications
  • Diagnosis, Differential
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasms / blood
  • Neoplasms / complications
  • Neoplasms / diagnosis*
  • ROC Curve
  • Retrospective Studies
  • Stroke / blood
  • Stroke / diagnosis*
  • Stroke / etiology
  • Young Adult

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D

Grant support

This study was supported by the Korean Healthcare Technology Research & Development Project, Ministry of Health & Welfare (A110208). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.